Permit CITY OF TIGARD ELECTRICAL PERMIT
1.14
8. • • COMMUNITY DEVELOPMENT Permit #: ELC2009 -00151
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/07/2009
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Chase Bank
Project Description: TI (6) branch circuits.
Owner: FEES
FRED MEYER STORES, INC Quantity Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO 6 crt Branch Circuits 04 /07/2009 $80.10
BOX 35547 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/07/2009 $9.61
Contractor: Electrical
OREGON ELECTRIC CONSTRUCTION INC
1010 SE 11TH AVE
PORTLAND, OR 97124
PHONE: 503 - 234 -9900
FAX: 503 - 535 -2763
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.71
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952-9W-0100. You may obtai a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: (' Re 4/V\ Permittee Signature: ' Z \ (1
/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N Date:
•
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
!si
` PR-06 -09 14:40 FROM— OREGON ELECT l/ 5032349900 T -515 P.002/002 F -799
• Electrical Permit Application I V '. I•tnt 011 r• 1t. t: t ,, i,.()\1.\
IN q City of Tigard Received
13125 SW Hall Blvd.. Tigard. OR 97223 APR — 6 2009 Plan Review 0 I 'fin No O . 0 0 `5
Phone: 503.639.4171 Fax: 503.598.1960 Dal : , Other P 12 00 , b-` 48
t , ,, a ,., Inspection Line: 503.639.4175 CITY OF TIGARD Date Rix 65 See Page 2 for
Internet: www.tigard-or.gov RUII DING DIVISION Ncdiuled/Method: ` Supplemental Infurmatitm
TYPE OF WORK • PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit2 sets of plans whims checked below):
1:1 Demolition Other ❑ Service or fender 400 amps or more ❑ Building Over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exacds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1- and 2 - family dwelling ® Commercial/industrial ❑ AccessO bu ildin less to ground or exceeds 14.000 ❑ Commercial use agticultursl
n' g amps for all other insta0atitms, buildings.
❑ Multi - family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emcrgcncy system. larger eepannety derived system,
❑ Addition of new motor load of ❑ "A ", "E". - 1.2 ", - 1.3 - ,
Job no.: 25195 I Job site address: 11565 SW PACIFIC HWY IOORP or mom. occupancy.
❑ Six or more rmidential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD OR ❑ Health -care facilitie. ❑ Supply voltage for mom th:m
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: CHASE BANK ❑ Service or Redcr 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty, I Fee. - I Total I •
New residential single- or multi- family dwelling unit
Includes attached garage. • -
Subdivision: Lot no.; 1.000 sq. R or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. 6.) 75 2
Limited energy, muhi• family '
BANK REMODEL, - residential (with above sq. ft.) 75.00 ' 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I ❑ TENANT
200 less 80.30 2
amps to
amps [0400 amps 106.85 2
Name: 401 amps 50 600 amps 160.60 2
- 601 amps to 1,000 amps 240.60 2
Address:
Over 1,000 amps or volts 454.65 2
City /State/ZIP': Temporary services or feeders installation, alteration, and/or
. relocation
Phone: ( ) Fax. ( ) 200 amps or less 66.85 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps I33.75 _ 2
•
Branch circuits —ue , extension, per pane
alteration, or extensil
Owner signature: Date: - -
A. Fee for branch circuits with _ I
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: __ ___ B. Fee for branch circuits
wirhoza service or feeder fee, 1 .46
wn. ruiaCi Odiuc: ' :' 2
es first branch circuit ""
Address: Each add'l branch circuit l 5 I 6.65 l 3325 1
• Miscellaneoussservice or feeder not included)
City /State/ZIP: Each ntm uftctured or modular 90.90 2
• dwelling, service and/or feeder
Phone: ( ) i Fax: : ( ) Reconnect only 66.85 2
E -mail:
Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: OREGON ELECTRIC Signal eiltaat(s) or limited
Address: 1010 SE 11 AVE energy Panel, alteration. t:r or Page 2
ctea,ioa Describe: P
City/State/Z1P: PORTLAND OR 97214 Each additional inspection over sllowablc in any of the above
Per inspection 62.50
Phone: (503) 234 -9900 I Fax: (503) 535 -2763 Investigation per hour (I hr min) 62.50
CCE Lie.: 203 Electrical Lie.: 26-95C Suprv. Lie.: 45495 Industrial plant per hour 73.75 I
� . ,� _ _ ELECTRICAL rERMI I FEES
Sup-v. Electrician signature, tt q � d' C�
'>\ "` � ' . Subtotal: 80.10
•
Print name: RICHARD MCELLiOTT I Date: 4-6-09 Plan review (25% of permit fee): I
• 17■ State surcharge (12% of permit fee): . 9.61 .
ituthori2Jeci sigllawre' �'ti Y, "..'C';'(-•:;,..----.. � -ter "_' i ' TOTAL PERMIT PE1 : � . 89.71 I
I ['Tint name; RiCHARD M.CELLIOTT Date: 4-6-09 w ( Thu permit application Gapires if a permit is not obtained within tsn
II days after It has been ncceprcd as complete.
. Number of inspection,: allowed per permit,
::1:ui1„h, .ra ;L[c.re.ml,Ape.doc 05/21'0;, .y.. _ ••-",•^- :40.451 ;T :I: 5.:LW'l ^CC